Bridging Disciplinary Boundaries (January 11 - 14, 2007)

Purpose: This study examined trauma exposure, mental health, and resiliency issues among Bosnian refugees who have been resettled in a Midwestern state within the United States of America for more than five years due to the 1992-1993 Bosnian conflict that left more than 200,000 people dead, many more wounded, and drove another half a million into exile. The study employed both quantitative and qualitative research methodologies.

Methods: A cross sectional survey design was employed with a package of 4 standardized measures that demonstrated good construct validity, internal consistency, and test-retest reliability (Mental Health Inventory; Traumatic Life Events Questionnaire Scale, PTSD Screening and Diagnostic Scale, and the Inventory of Complicated Grief). These measures were translated into Bosnian using back translation methods. Distribution of 500 surveys resulted in a convenience sample of 126 (25.2%) surveys returned. The sample was predominately female (56%) with a mean age of 42. Face to face interviews were conducted with seven individuals that scored high on the well being measure and a thematic analysis of the transcribed interviews using Atlas/ti was conducted.

Findings: The total number of traumatic events experienced by the refugees ranged from 0 to 12 events with a mean of 5.2 traumatic events. 53.7% of the refugees scored in the range of PTSD symptoms that are generally confirmed for a full diagnosis of PTSD, a rate nearly 6 times higher than the general U.S. population estimates of 8%. 67.2% lost close relatives or friends as a result of the conflicts in Bosnia and being a refugee. Multiple regression analysis revealed that Complicated Grief (p< .01) was a significant predictor of Post Traumatic Stress in Bosnians five years after settlement. Qualitative interviews revealed that the largest factor that led to resilience was deriving hope from the context of the extended family unit.

Implications: The findings of this research suggest that refugees still suffer from symptoms of PTSD, complicated grief, and depression well after their initial resettlement period here in the United States. Interventions that target grief in the context of the culture and that use the close extended family relations of Bosnian refugees may help address their numerous psychosocial needs. Yet, it is important to remember that a considerable percentage are showing great resiliency as indicated by measures of well-being in relation to the massive trauma they experienced as a result of the civil war, ethnic cleansing, and refugee experience in Bosnia and other countries.